The incidence of breast cancer is rising in every country of the world especially in developing countries such as India. This is because more and more women in India are beginning to work outside their homes which allows the various risk factors of breast cancer to come into play. These include late age at first childbirth, fewer children and shorter duration of breast-feeding. Of these, the first is the most important. In addition, early age at menarche and late age at menopause add to the risk to some extent. Family history of breast cancer increases the risk as follows: if a woman has a mother who has suffered from breast cancer her risk increases about 3 fold while having a sister with cancer, the risk increases by about 2-3 fold. About 5% of breast cancers are hereditary, i.e. due to a gene being transmitted either from the father or from the mother. Typically, these families have many members who fall victim to the disease, which tends to occur at a relatively young age and often affects both breasts. Two genes namely BRCA1 and BRCA2 have been identified although genetic testing, because of ethical, emotional and social implications that they carry, is still in the sphere of research in most developed countries except the U.S. Thankfully, the incidence of breast cancer is much lower in India compared to western countries. The incidence varies between urban and rural women; the incidence in Mumbai is about 27 new cases per 100,000 women per year while in rural Maharashtra it is only 8 per 100,000. The chances of cure in women who develop the disease is related to early diagnosis. There are 3 methods for early detection of breast cancer. Mammography i.e. X-ray of the breast, done at regular intervals, say every 2 years, is popular in the west. However, mammography is expensive, technology driven and requires stringent quality control and extensive experience on the part of technicians and doctors involved. If these are not available, mammography can do more harm than good by falsely diagnosing cancer or missing it when it is actually present. I would personally recommend mammography only in women who have a family history of breast cancer or other risk factors. The second method is for a woman to get herself examined clinically be a breast specialist. It appears that if clinical examination is done properly it may be as effective as mammography. The third method is self-examination whereby a woman examines her own breasts once a month after taking lessons from an expert. Many women however do not like doing self-examination often out of fear of finding cancer. Nevertheless evidence suggests that if the examination is done properly and regularly, it may help to detect breast cancer early. Typically, breast cancer arises from cells lining the milk ducts and slowly grows into a lump. It is thought that it takes about 10 years for a tumour to become 1 cm in size starting from a single cell. Once breast cancer develops, surgery is the usual treatment. If detected early enough, the breast can be conserved by removal of the lump alone without a mastectomy. In this case, the glands in the armpit are also removed. This treatment is followed by radiotherapy to the breast. Chemotherapy is usually given as an adjunct to surgery to kill any stray cells that might have escaped and lodged elsewhere. Anti-oestrogen drugs are also used very effectively in women whose tumours are responsive to hormones. The latter is determined by a laboratory test called oestrogen receptor test. Sometimes chemotherapy is given first to reduce the size of the tumour so that breast conserving surgery can be performed. Once breast cancer spreads to other organs the disease usually becomes incurable and the treatment is directed at relieving symptoms, if any. Nevertheless, much can be achieved with treatment by anti-hormone medications as well as chemotherapy and radiotherapy. Many young women experience pain in their breasts, especially before their periods. Pain in the breast is usually not related to cancer and often settles down on its own. If severe, painkillers can be taken. Pain in the breast is rare after menopause. Many women have lumpy breasts which in medical jargon is called “fibroadenosis†. This again is not a precursor of cancer. Lumps in the breast in premenopausal women may sometime be caused by cysts containing fluid. This can be aspirated with a needle which usually cures the condition. Younger women sometimes have solid non-cancerous lumps called “fibroadenoma†which usually requires removal under local anaesthesia. Discharge from the nipple is not uncommon, but if it is bloody, this may sometimes indicate the presence of early cancer. To conclude, do not ignore a lump in the breast â€" see a doctor.
-Professor Indraneel Mittra
Professor of Surgery and Consultant Surgeon and Scientist,
Tata Memorial Hospital, Mumbai
Article from NDTV DOCTOR
Wednesday, February 25, 2009
Sunday, February 22, 2009
Passive smoking linked to dementia
Passive smoking appears to significantly raise a person's risk of dementia and other forms of cognitive problems. Research has linked passive smoking to a range of conditions including lung cancer and heart disease. Previous studies have also identified that smoking increases the chances of dementia and other forms of cognitive impairment but it was not as clear whether the same held true for second-hand smoke.To examine the association between exposure to second-hand smoke and cognitive impairment, researchers from Britain followed 4809 non-smoking adults aged 50 years or more. The researchers examined saliva samples of the participants and tested the saliva for cotinine, a product of nicotine found in saliva for about 25 hours after exposure to second-hand smoke, to measure of exposure to cigarettes. It was found that those who were exposed to second hand smoke had 44 percent increased risk of developing dementia and other cognitive impairments. The results suggest that inhaling other people's smoke may damage the brain, impair cognitive functions such as memory, and make dementia more likely. The findings could be attributed to the fact that exposure to second-hand smoke increases the risk of heart disease and stroke, conditions that increase the risks of dementia and other cognitive problems.
About cancer
What is cancer?
Cancer is the generic term used to describe a group of disorders caused by an uncontrolled multiplication of cells, which usually resulting in the destruction of neighbouring tissues. Gradually, these tissues and organs stop functioning and death may occur.The reasons for cells to start multiplying is unknown in most cases. They may have some inbuilt abnormality or may be affected by external influences. What are the common terms associated with cancer?Since cancer is a group of disorders, there are some terms commonly used in the description of the disease.
Oncology : "onco" meaning 'cancer', oncology is the study of various types of cancers.
Tumour: A lump resulting from an uncontrolled growth of cells which may be malignant or benign.
Malignant: A growth of cells that destroys the surrounding tissue and spreads to other parts of the body.
Benign: A growth of cells that is not cancerous. Both benign and malignant growths are unwanted multiplications of cells, but whereas a benign growth does not generally leave the place of its origin, a malignant growth usually destroys not only the tissue of its origin but also the surrounding ones. This is why cancers are caused due to malignant growths, which spread to all areas of the body.
Carcinoma: A term synonymously used with cancer. But carcinomas are specifically malignant tumours mostly forming on the outlines (epithelium) of the affected organ. It is the most frequently occurring form of cancer.
Sarcoma: Another form of cancer where specifically the connective tissue (that which supports the various parts of the body), is affected. It is a malignant form and cancers of the blood, lymphatic system, bone and the like, fall under this category.
What are the symptoms?
Cancers appear in many different ways. Most often they are noticed as a lump or growth in some part of the body. This is the case with tumours that form on the outlines of organs. When the cancerous growth is not physically identifiable, there may be other revealing symptoms depending on the form of cancer and the affected organ.Cancer in the brain may have symptoms like headache, vomiting, difficulty in walking, paralysis and memory problems. Tumours of the intestine can present problems in bowel movements and pain in the stomach. Lung cancers may be manifested by difficulty in breathing and cough. Cancers of the breast are detected as a painless lump. There may also be some deformity of one or both breasts in some cases. Some malignant tumours are manifested by abnormal bleeding from the affected organ. For example, cancer of the intestine may result in loss of blood in stools. Similarly, lung cancer may be detected when the patient passes blood in the sputum. Pain, as popularly believed, is not a common symptom of cancer. It only occurs in some cases where a nerve is pressed due to rapid enlargement of a tumour. Other symptoms that may be common to all forms of cancer are a lack of appetite, unexplained loss of weight, general feeling of weakness and fatigue and increased proneness to infections.How is it diagnosed?In case blood is passed in stools or cough, the patient should see a doctor. For confirmation, a biopsy of the affected organ is done. In this procedure, a small part of the tissue is taken for laboratory testing to detect the presence of cancerous cells.In case of cancer of the lungs, liver, stomach or intestine, an X-ray or ultrasound of the area may be taken. CT scans of the organs may also be done for diagnosis. The diagnosis is always made keeping in mind the patient’s previous medical history.What is the treatment?Treatment is most effective if the cancer is detected early. Chemotherapy is the most common method of treatment for cancer that has spread to other parts of the body. In this procedure, the malignant cells are destroyed with the help of powerful chemicals like methotrexate and vincristine which are given intra-venously i.e. directly injected into the veins. This procedure requires a hospital stay for the duration of therapy. It is also associated with various side effects like loss of hair, nausea, vomiting, loss of appetite and weakness for some days.For a tumour that has not spread, radiotherapy or radiation, or surgery may be done. In the former, the cells are destroyed with the help of strong radioactive waves. The exact position of the tumour is marked and the area is exposed to radiation under strictly controlled conditions. This treatment is given in breaks and in pre-determined doses. Tumours that develop in organs under hormonal control like the breast, thyroid or prostate, may also be treated with endocrine therapy. In this treatment, either the source of the hormone is removed or anti-hormone drugs are given. This treatment scores over chemotherapy because it usually has less severe side effects. But the doctor decides the best course of treatment depending on the diagnosis of the form of cancer.
Cancer is the generic term used to describe a group of disorders caused by an uncontrolled multiplication of cells, which usually resulting in the destruction of neighbouring tissues. Gradually, these tissues and organs stop functioning and death may occur.The reasons for cells to start multiplying is unknown in most cases. They may have some inbuilt abnormality or may be affected by external influences. What are the common terms associated with cancer?Since cancer is a group of disorders, there are some terms commonly used in the description of the disease.
Oncology : "onco" meaning 'cancer', oncology is the study of various types of cancers.
Tumour: A lump resulting from an uncontrolled growth of cells which may be malignant or benign.
Malignant: A growth of cells that destroys the surrounding tissue and spreads to other parts of the body.
Benign: A growth of cells that is not cancerous. Both benign and malignant growths are unwanted multiplications of cells, but whereas a benign growth does not generally leave the place of its origin, a malignant growth usually destroys not only the tissue of its origin but also the surrounding ones. This is why cancers are caused due to malignant growths, which spread to all areas of the body.
Carcinoma: A term synonymously used with cancer. But carcinomas are specifically malignant tumours mostly forming on the outlines (epithelium) of the affected organ. It is the most frequently occurring form of cancer.
Sarcoma: Another form of cancer where specifically the connective tissue (that which supports the various parts of the body), is affected. It is a malignant form and cancers of the blood, lymphatic system, bone and the like, fall under this category.
What are the symptoms?
Cancers appear in many different ways. Most often they are noticed as a lump or growth in some part of the body. This is the case with tumours that form on the outlines of organs. When the cancerous growth is not physically identifiable, there may be other revealing symptoms depending on the form of cancer and the affected organ.Cancer in the brain may have symptoms like headache, vomiting, difficulty in walking, paralysis and memory problems. Tumours of the intestine can present problems in bowel movements and pain in the stomach. Lung cancers may be manifested by difficulty in breathing and cough. Cancers of the breast are detected as a painless lump. There may also be some deformity of one or both breasts in some cases. Some malignant tumours are manifested by abnormal bleeding from the affected organ. For example, cancer of the intestine may result in loss of blood in stools. Similarly, lung cancer may be detected when the patient passes blood in the sputum. Pain, as popularly believed, is not a common symptom of cancer. It only occurs in some cases where a nerve is pressed due to rapid enlargement of a tumour. Other symptoms that may be common to all forms of cancer are a lack of appetite, unexplained loss of weight, general feeling of weakness and fatigue and increased proneness to infections.How is it diagnosed?In case blood is passed in stools or cough, the patient should see a doctor. For confirmation, a biopsy of the affected organ is done. In this procedure, a small part of the tissue is taken for laboratory testing to detect the presence of cancerous cells.In case of cancer of the lungs, liver, stomach or intestine, an X-ray or ultrasound of the area may be taken. CT scans of the organs may also be done for diagnosis. The diagnosis is always made keeping in mind the patient’s previous medical history.What is the treatment?Treatment is most effective if the cancer is detected early. Chemotherapy is the most common method of treatment for cancer that has spread to other parts of the body. In this procedure, the malignant cells are destroyed with the help of powerful chemicals like methotrexate and vincristine which are given intra-venously i.e. directly injected into the veins. This procedure requires a hospital stay for the duration of therapy. It is also associated with various side effects like loss of hair, nausea, vomiting, loss of appetite and weakness for some days.For a tumour that has not spread, radiotherapy or radiation, or surgery may be done. In the former, the cells are destroyed with the help of strong radioactive waves. The exact position of the tumour is marked and the area is exposed to radiation under strictly controlled conditions. This treatment is given in breaks and in pre-determined doses. Tumours that develop in organs under hormonal control like the breast, thyroid or prostate, may also be treated with endocrine therapy. In this treatment, either the source of the hormone is removed or anti-hormone drugs are given. This treatment scores over chemotherapy because it usually has less severe side effects. But the doctor decides the best course of treatment depending on the diagnosis of the form of cancer.
Saturday, February 7, 2009
Early detection can help nip cancer in the bud
There will be 14 lakh new cases of cancer every year by 2026. If that is dangerous, then digest this. The WHO estimates that 84 million people will die of cancer between 2005 and 2015, without intervention!
Cancer has become one of the 10 leading causes of death in India. At any given point of time, there are nearly 1.5 million cancer cases.
Data from population-based registries under the National Cancer Registry Programme indicate that the leading sites of cancer are oral cavity, lungs, oesophagus and stomach among men, and cervix, breast and oral cavity among women. Cancers, namely oral and in lungs in males, and cervix and breast in females, account for over 50% of all cancer deaths in India.
WHO has estimated that 91 per cent of oral cancers in South-East Asia are directly attributable to the use of tobacco, and is the leading cause of oral cavity and lung cancer in India.
What is cancer?
Cancer is an abnormal growth of a cell or an organ due to a specific stimulus (carcinogen). This growth is an uncoordinated, purposeless one, which continues to grow even after the cessation or withdrawal of the stimulus.
What are the types of cancer?
Cancer can originate from any organ or part of the body. The natural behaviour of a particular cancer depends upon the site of involvement and the histopathological type of the cancer. Some of the cancers are very mild and can be controlled very easily, while some are very aggressive and results of treatment are very poor.
How does cancer spread?
As cancer grows, it invades the surrounding structures and interferes with local function. It spreads to the draining lymph nodes through the lymphatic. Through the blood streams, it spreads to the other parts of the body. The common organs of distant metastasis are lung, liver, bones, brain etc.
What are the causes of cancer?
The exact cause of cancer is not yet known. However, there are certain risk factors, which may cause this disease in individuals prone to cancer. Among the common factors are chemicals, which may be in the form of tobacco or chemicals present in food, air, water, etc. These chemicals are known as carcinogens. Till now, about 60 agents have been identified.
Some common risk factors of cancer
* Tobacco
Smoking: Cigarette, beedi, cigar, hukka, others
Smokeless: Zarda, gutka, khaini, snuff etc
* Alcohol
* Infections (viruses, parasites, bacteria)
* Electromagnetic radiation (ionising radiation, ultraviolet rays, others)
* Diet (dietary carcinogens)
* Occupational exposure to carcinogens
* Pollution (air/water/food)
* Reproductive hormones
* Heredity
Is cancer a preventable disease?
In a majority of Indian patients, cancer can definitely be prevented. About 50% of cancers are tobacco-related eg. lung cancer, oral cancer (cancer of mouth), laryngeal cancer (voice box), oesophageal cancer (food pipe) and they can be prevented to a large extent by avoiding intake of tobacco. Certain other cancers like bowel cancer can also be prevented by dietary habits.
What are the signs and symptoms of cancer?
The signs and symptoms depend upon the body part affected by the disease. The primary tumour or spread of tumour to lymph nodes or distant parts of the body may cause symptoms. In general, cancer has a tendency to start as a nodule or mass of tissue, which keeps on growing. The growth rate of cancers is variable, with some growing very rapidly and others growing slowly. With further growth, cancers which affect external or internal body surfaces can form wounds or ulcers, leading to dirty discharge, bleeding etc.
Common symptoms of cancer can be described as follows.
Lump or swelling:
A sore that doesn't heal:
Recent change in a wart/mole:
Unusual bleeding or discharge:
Changes in bladder or bowel habits:
Nagging cough or hoarseness:
Difficulty in swallowing or dyspepsia:
Is cancer curable?
Yes, if detected early. The results of treatment in stage I and stage II (early stage Cancer) are about 80%. In late stage diseases (Stage III & Stage IV) the results are very poor. (Less than 20%). In India, about 70% patients present in advanced stage diseases and hence difficult to treat.
How is cancer treated?
Basically, there are three main modalities of Cancer treatment - Surgery, Radiotherapy and Chemotherapy (Drugs). The treatment of cancer is described as a multimodality approach as a large number of patients need to be treated with a combination of the approaches available. Thus, some patients may need only one modality of treatment, some need a combination of two modalities and some need to be treated with all three modalities to achieve the best results. To decide the best treatment for a given patient, initial testing is done to make the diagnosis (diagnostic investigations) and decide the stage of disease (staging investigations). After the initial treatment plan, the treatment is started. The progress of treatment and response of disease is assessed from time to time. A review of the progress is made in subsequent tumour board meetings to decide whether any change in the treatment plan is required or not. Once the planned treatment is completed, cancer patients need regular follow-up.
Cancer has become one of the 10 leading causes of death in India. At any given point of time, there are nearly 1.5 million cancer cases.
Data from population-based registries under the National Cancer Registry Programme indicate that the leading sites of cancer are oral cavity, lungs, oesophagus and stomach among men, and cervix, breast and oral cavity among women. Cancers, namely oral and in lungs in males, and cervix and breast in females, account for over 50% of all cancer deaths in India.
WHO has estimated that 91 per cent of oral cancers in South-East Asia are directly attributable to the use of tobacco, and is the leading cause of oral cavity and lung cancer in India.
What is cancer?
Cancer is an abnormal growth of a cell or an organ due to a specific stimulus (carcinogen). This growth is an uncoordinated, purposeless one, which continues to grow even after the cessation or withdrawal of the stimulus.
What are the types of cancer?
Cancer can originate from any organ or part of the body. The natural behaviour of a particular cancer depends upon the site of involvement and the histopathological type of the cancer. Some of the cancers are very mild and can be controlled very easily, while some are very aggressive and results of treatment are very poor.
How does cancer spread?
As cancer grows, it invades the surrounding structures and interferes with local function. It spreads to the draining lymph nodes through the lymphatic. Through the blood streams, it spreads to the other parts of the body. The common organs of distant metastasis are lung, liver, bones, brain etc.
What are the causes of cancer?
The exact cause of cancer is not yet known. However, there are certain risk factors, which may cause this disease in individuals prone to cancer. Among the common factors are chemicals, which may be in the form of tobacco or chemicals present in food, air, water, etc. These chemicals are known as carcinogens. Till now, about 60 agents have been identified.
Some common risk factors of cancer
* Tobacco
Smoking: Cigarette, beedi, cigar, hukka, others
Smokeless: Zarda, gutka, khaini, snuff etc
* Alcohol
* Infections (viruses, parasites, bacteria)
* Electromagnetic radiation (ionising radiation, ultraviolet rays, others)
* Diet (dietary carcinogens)
* Occupational exposure to carcinogens
* Pollution (air/water/food)
* Reproductive hormones
* Heredity
Is cancer a preventable disease?
In a majority of Indian patients, cancer can definitely be prevented. About 50% of cancers are tobacco-related eg. lung cancer, oral cancer (cancer of mouth), laryngeal cancer (voice box), oesophageal cancer (food pipe) and they can be prevented to a large extent by avoiding intake of tobacco. Certain other cancers like bowel cancer can also be prevented by dietary habits.
What are the signs and symptoms of cancer?
The signs and symptoms depend upon the body part affected by the disease. The primary tumour or spread of tumour to lymph nodes or distant parts of the body may cause symptoms. In general, cancer has a tendency to start as a nodule or mass of tissue, which keeps on growing. The growth rate of cancers is variable, with some growing very rapidly and others growing slowly. With further growth, cancers which affect external or internal body surfaces can form wounds or ulcers, leading to dirty discharge, bleeding etc.
Common symptoms of cancer can be described as follows.
Lump or swelling:
A sore that doesn't heal:
Recent change in a wart/mole:
Unusual bleeding or discharge:
Changes in bladder or bowel habits:
Nagging cough or hoarseness:
Difficulty in swallowing or dyspepsia:
Is cancer curable?
Yes, if detected early. The results of treatment in stage I and stage II (early stage Cancer) are about 80%. In late stage diseases (Stage III & Stage IV) the results are very poor. (Less than 20%). In India, about 70% patients present in advanced stage diseases and hence difficult to treat.
How is cancer treated?
Basically, there are three main modalities of Cancer treatment - Surgery, Radiotherapy and Chemotherapy (Drugs). The treatment of cancer is described as a multimodality approach as a large number of patients need to be treated with a combination of the approaches available. Thus, some patients may need only one modality of treatment, some need a combination of two modalities and some need to be treated with all three modalities to achieve the best results. To decide the best treatment for a given patient, initial testing is done to make the diagnosis (diagnostic investigations) and decide the stage of disease (staging investigations). After the initial treatment plan, the treatment is started. The progress of treatment and response of disease is assessed from time to time. A review of the progress is made in subsequent tumour board meetings to decide whether any change in the treatment plan is required or not. Once the planned treatment is completed, cancer patients need regular follow-up.
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